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Kuykendall AT, Fine JT, Kremyanskaya M. Contemporary Challenges in Polycythemia Vera Management From the Perspective of Patients and Physicians. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:512-522. [PMID: 38749802 DOI: 10.1016/j.clml.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 07/30/2024]
Abstract
Although polycythemia vera (PV) is a chronic and incurable disease, effective management can allow most patients to maintain functional lives with near-normal life expectancy. However, there remain several inter-related factors that contribute to many ongoing challenges associated with the management of PV, which this review aims to explore. First, as a disease hallmarked by constitutive activation of the JAK/STAT pathway, PV is often accompanied by inflammatory symptoms that negatively impact quality of life. Next, patients often require recurrent therapeutic phlebotomies to maintain their hematocrit below the 45% threshold that has been associated with a decreased risk of thrombotic events. The need to closely monitor hematocrit and perform conditional therapeutic phlebotomies ties patients to the healthcare system, thereby limiting their autonomy. Furthermore, many patients describe therapeutic phlebotomies as burdensome and the procedure is often poorly tolerated, further contributing to quality-of-life decline. Phlebotomy needs can be reduced by utilizing cytoreductive therapy; however, standard first-line cytoreductive options (i.e., hydroxyurea and interferon) have not been shown to significantly improve symptom burden. Collectively, current PV management, while reducing thrombotic risk, often has a negative impact on patient quality of life. As researchers continue to advance towards the goal of developing a disease-modifying therapy for patients with PV, pursuit of nearer-term opportunities to shift the current treatment paradigm towards improving symptoms without compromising quality of life is also warranted, for example, by reducing or eliminating the frequent use of phlebotomy.
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Affiliation(s)
- Andrew T Kuykendall
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL.
| | | | - Marina Kremyanskaya
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Fernando G, Preston N. Refractory pruritus from malignant cholestasis: management. BMJ Support Palliat Care 2023; 13:e78-e80. [PMID: 31932473 DOI: 10.1136/bmjspcare-2019-002051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/23/2019] [Indexed: 11/04/2022]
Abstract
This case report deals with a patient managed in a tertiary-care cancer hospital who suffered pruritus associated with malignant cholestasis. His symptoms were resistant to conventional treatment with ursodeoxycholic acid, chlorpheniramine and cholestyramine. Hence, the multifactorial origin of malignancy-associated pruritus was considered. Correctable factors were corrected and generally the treatment was aimed at possible aetiologies. There were barriers related to insufficient resources available for symptom palliation in this particular setting, which could potentially reduce optimum symptom control. However, various pharmacotherapies and non-pharmacological measures which could potentially have helped relieve pruritus are described and future scope for research in this area discussed.
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Affiliation(s)
- Gvmc Fernando
- National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Department of Family Medicine, University of Sri Jayewardenepura Faculty of Medical Sciences, Nugegoda, Sri Lanka
| | - Nancy Preston
- International Observatory of End of Life Care, Lancaster University, Lancaster, UK
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3
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Considerations to comprehensive care for the older individual with myelofibrosis. Best Pract Res Clin Haematol 2022; 35:101371. [DOI: 10.1016/j.beha.2022.101371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 11/17/2022]
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Eeltink C, Embaby A, Incrocci L, Ket JCF, Liptrott SJ, Verdonck-de Leeuw I, Zweegman S. Sexual problems in patients with hematological diseases: a systematic literature review. Support Care Cancer 2022; 30:4603-4616. [DOI: 10.1007/s00520-021-06731-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
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Gowin K, Langlais BT, Kosiorek HE, Dueck A, Millstine D, Huberty J, Eckert R, Mesa RA. The SIMM study: Survey of integrative medicine in myeloproliferative neoplasms. Cancer Med 2020; 9:9445-9453. [PMID: 33140580 PMCID: PMC7774715 DOI: 10.1002/cam4.3566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/25/2020] [Accepted: 09/30/2020] [Indexed: 12/22/2022] Open
Abstract
Myeloproliferative neoplasms (MPNs) are characterized by significant symptom burden. Integrative medicine (IM) offers unique symptom management strategies. This study describes IM interventions utilized by MPN patients and the association with symptom burden, quality of life, depression, and fatigue adjusted for lifestyle confounders. MPN patients were surveyed online for IM utilization, MPN symptom burden (MPN‐Symptom Assessment Form Total Symptom Score), depression (Patient Health Questionnaire), fatigue (Brief Fatigue Inventory), and a single question on overall quality of life. Measures were compared by IM participation and adjusted for alcohol and tobacco use, BMI, diet, and MPN type using multiple linear and logistic regression. A total of 858 participants were included in the analysis. Aerobic activity (p =< 0.001) and strength training (p = 0.01) were associated with lower mean symptom burden while massage (p =< 0.001) and support groups (p =< 0.001) were associated with higher levels of symptom burden. Higher quality of life was reported in massage (p = 0.04) and support groups (p = 0.002) while lower quality of life was noted in aerobic activity (p =< 0.001) and strength training (p = 0.001). A lower depression screening score was noted in those participating in aerobic activity (p = 0.006), yoga (p = 0.03), and strength training (p = 0.02). Lower fatigue was noted in those participating in aerobic activity (p =< 0.001) and strength training (p = 0.03) while higher fatigue was noted in those participating in massage (p =< 0.001) and breathing techniques (p = 0.02). Data available on request from the authors. This international survey of MPN patients on IM usage, has shown that patients who participated in a form of IM had a pattern of decreased levels of symptom burden, fatigue, depression, and higher QoL, as adjusted for health lifestyle practices overall.
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Affiliation(s)
- Krisstina Gowin
- Department of Hematology, University of Arizona, Tucson, AZ, USA
| | - Blake T Langlais
- Department of Biostatistics, Mayo Clinic, Phoenix, Phoenix, AZ, USA
| | - Heidi E Kosiorek
- Department of Biostatistics, Mayo Clinic, Phoenix, Phoenix, AZ, USA
| | - Amylou Dueck
- Department of Biostatistics, Mayo Clinic, Phoenix, Phoenix, AZ, USA
| | - Denise Millstine
- Integrative Medicine Program, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Jennifer Huberty
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Ryan Eckert
- Mays Cancer Center, University of Texas, San Antonio, TX, USA
| | - Ruben A Mesa
- Mays Cancer Center, University of Texas, San Antonio, TX, USA
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McFarland DC, Nelson C, Miller AH. Early childhood adversity in adult patients with metastatic lung cancer: Cross-sectional analysis of symptom burden and inflammation. Brain Behav Immun 2020; 90:167-173. [PMID: 32791210 PMCID: PMC7544656 DOI: 10.1016/j.bbi.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/24/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Psychological and physical symptoms commonly occur in patients with metastatic lung cancer and are associated with reduced quality of life and decreased survival. Previous work has associated these symptoms with inflammation. The experience of Early Childhood Adversity (ECA) is linked to chronic inflammation and may identify adult cancer patients who are at-risk for psychological and physical symptoms. We thus hypothesized that ECA in lung cancer patients would be associated with increased psychological symptoms (distress, anxiety, and depression) and physical symptoms and that this relationship would be explained by inflammation. METHODS Patients with metastatic lung cancer (n = 92) were evaluated for ECA using the Risky Families Questionnaire. Concomitant assessments were made of distress (Distress Thermometer and Problem List [DT&PL]), anxiety (Generalized Anxiety Disorder-7), depression (Patient Hospital Questionniare-9), physical symptoms (DT&PL), and inflammation (C-reactive protein [CRP]). Multivariate models were created to explain associations of ECA with depression, anxiety, distress, number of physical problems, and inflammation. RESULTS ECA was associated with distress (r = 0.24, p = .03), anxiety (r = 0.30, p = .004), depression (r = 0.35, p = .001), greater physical problems (r = 0.25, p = .03), younger age (r = -0.29, p = .006), and elevated CRP (r = 0.22, p = .04). Multivariate analyses of outcomes found that depression severity was independently explained by both ECA and inflammation (β = 0.37, p = .001) but not distress or anxiety, while controlling for age and sex. Number of physical problems were also associated with ECA (β = 0.35, p = .004) but not inflammation. The association between ECA and physical problems was not significant after controlling for depression. CONCLUSION ECA is associated with increased depression and physical symptoms independent of inflammation. Moreover, depression appears to mediate the impact of ECA on physical symptoms. ECA may identify patients at risk for psychological and physical symptoms.
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Affiliation(s)
- Daniel C. McFarland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States,Corresponding author at: Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, New York, NY 10024, United States, (D.C. McFarland)
| | - Christian Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andrew H. Miller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
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Padrnos L, Scherber R, Geyer H, Langlais BT, Dueck AC, Kosiorek HE, Senyak Z, Clark M, Boxer M, Cotter M, Harrison C, Stonnington C, Geda Y, Mesa R. Depressive symptoms and myeloproliferative neoplasms: Understanding the confounding factor in a complex condition. Cancer Med 2020; 9:8301-8309. [PMID: 32976697 PMCID: PMC7666736 DOI: 10.1002/cam4.3380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/17/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022] Open
Abstract
Background Philadelphia chromosome negative myeloproliferative neoplasms (MPNs), including essential thrombocythemia, polycythemia vera, and myelofibrosis, have severe function‐limiting symptom burden that is experienced by the majority of patients. Previous studies have suggested that depression may be present in over a quarter of MPN patients, but to date no studies have evaluated the relationship between depression and other variables such as symptoms. Methods A 70‐item internet based survey regarding fatigue and mood symptoms was developed by a multidisciplinary team of MPN investigators, patients and patient advocates including Patient Health Questionnaire and the Myeloproliferative Neoplasm Symptom Assessment Form was completed by over 1300 patients with MPN diagnosis. Results There were 309 respondents (23%) with PHQ‐2 scores ≥ 3. In this analysis, we found worse systemic symptom burden in individuals reporting depressive symptoms. Conclusion This analysis suggests the importance of depression in contributing to as well as confounding symptomatology in MPN patients, and suggests that this critical variable should also be addressed by clinicians and researchers alike when comprehensively assessing symptom burden etiologies.
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Affiliation(s)
- Leslie Padrnos
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Robyn Scherber
- Department of Hematology and Oncology, UT Health San Antonio MD Anderson Cancer Center, San Antonio, Portland, Texas, Oregon, USA
| | - Holly Geyer
- Division of Hospital Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Amylou C Dueck
- Division of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Zhenya Senyak
- MPN Forum, MPN Research Foundation, Chicago, IL, USA
| | - Matthew Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Mary Cotter
- MPN Forum, MPN Research Foundation, Chicago, IL, USA
| | - Claire Harrison
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,MPN Voice, London, United Kingdom
| | | | - Yonas Geda
- Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, AZ, USA.,Center for Bioelectronics and Biosensors, Arizona State University, Tempe, AZ, USA
| | - Ruben Mesa
- Department of Hematology and Oncology, UT Health San Antonio MD Anderson Cancer Center, San Antonio, Portland, Texas, Oregon, USA
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Ramanathan G, Craver-Hoover B, Arechavala RJ, Herman DA, Chen JH, Lai HY, Renusch SR, Kleinman MT, Fleischman AG. E-Cigarette Exposure Decreases Bone Marrow Hematopoietic Progenitor Cells. Cancers (Basel) 2020; 12:E2292. [PMID: 32824092 PMCID: PMC7464997 DOI: 10.3390/cancers12082292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/09/2020] [Accepted: 08/09/2020] [Indexed: 12/11/2022] Open
Abstract
Electronic cigarettes (E-cigs) generate nicotine containing aerosols for inhalation and have emerged as a popular tobacco product among adolescents and young adults, yet little is known about their health effects due to their relatively recent introduction. Few studies have assessed the long-term effects of inhaling E-cigarette smoke or vapor. Here, we show that two months of E-cigarette exposure causes suppression of bone marrow hematopoietic stem and progenitor cells (HSPCs). Specifically, the common myeloid progenitors and granulocyte-macrophage progenitors were decreased in E-cig exposed animals compared to air exposed mice. Competitive reconstitution in bone marrow transplants was not affected by two months of E-cig exposure. When air and E-cig exposed mice were challenged with an inflammatory stimulus using lipopolysaccharide (LPS), competitive fitness between the two groups was not significantly different. However, mice transplanted with bone marrow from E-cigarette plus LPS exposed mice had elevated monocytes in their peripheral blood at five months post-transplant indicating a myeloid bias similar to responses of aged hematopoietic stem cells (HSC) to an acute inflammatory challenge. We also investigated whether E-cigarette exposure enhances the selective advantage of hematopoietic cells with myeloid malignancy associated mutations. E-cigarette exposure for one month slightly increased JAK2V617F mutant cells in peripheral blood but did not have an impact on TET2-/- cells. Altogether, our findings reveal that chronic E-cigarette exposure for two months alters the bone marrow HSPC populations but does not affect HSC reconstitution in primary transplants.
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Affiliation(s)
- Gajalakshmi Ramanathan
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA 92697, USA;
| | - Brianna Craver-Hoover
- Department of Biological Chemistry, University of California, Irvine, CA 92617, USA; (B.C.-H.); (J.H.C.); (H.Y.L.)
| | - Rebecca J. Arechavala
- Division of Occupational and Environmental Medicine, University of California, Irvine, CA 92617, USA; (R.J.A.); (D.A.H.); (S.R.R.); (M.T.K.)
| | - David A. Herman
- Division of Occupational and Environmental Medicine, University of California, Irvine, CA 92617, USA; (R.J.A.); (D.A.H.); (S.R.R.); (M.T.K.)
| | - Jane H. Chen
- Department of Biological Chemistry, University of California, Irvine, CA 92617, USA; (B.C.-H.); (J.H.C.); (H.Y.L.)
| | - Hew Yeng Lai
- Department of Biological Chemistry, University of California, Irvine, CA 92617, USA; (B.C.-H.); (J.H.C.); (H.Y.L.)
| | - Samantha R. Renusch
- Division of Occupational and Environmental Medicine, University of California, Irvine, CA 92617, USA; (R.J.A.); (D.A.H.); (S.R.R.); (M.T.K.)
| | - Michael T. Kleinman
- Division of Occupational and Environmental Medicine, University of California, Irvine, CA 92617, USA; (R.J.A.); (D.A.H.); (S.R.R.); (M.T.K.)
| | - Angela G. Fleischman
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA 92697, USA;
- Department of Biological Chemistry, University of California, Irvine, CA 92617, USA; (B.C.-H.); (J.H.C.); (H.Y.L.)
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Abstract
Patients with myeloproliferative neoplasms (MPNs), a group of rare haematological conditions including polycythaemia vera, essential thrombocythaemia, and myelofibrosis, often experience a range of symptoms which can significantly impact their quality of life (QoL). Although symptom burden is highest in myelofibrosis and high-risk patients, lower-risk patients also report symptoms impacting their daily life and ability to work. In addition to physical symptoms, MPNs affect emotional well-being, with anxiety and depression frequently reported by patients. Despite significant advances in treatment options, such as the introduction of JAK1/JAK2 inhibitors, therapy for MPNs is often palliative; therefore, reduction of symptoms and improvement of QoL should be considered as major treatment goals. One of the main issues impacting MPN treatment is the discord between patient and physician perceptions of symptom burden, treatment goals, and expectations. New technologies, such as app-based reporting, can aid this communication, but are still not widely implemented. Additionally, regional variation further affects the psychosocial burden of MPNs on patients and their associates, as treatments and access to clinical trials are options for patients living in some areas, but not others. Overcoming some of the challenges in patient-physician communication and treatment access are key to improving disease management and QoL, as well as giving the patient greater input in treatment decisions.
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Affiliation(s)
- Cheryl Petruk
- Canadian MPN Research Foundation, Edmonton, AB, Canada.
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Surapaneni P, Scherber RM. Integrative Approaches to Managing Myeloproliferative Neoplasms: the Role of Nutrition, Exercise, and Psychological Interventions. Curr Hematol Malig Rep 2019; 14:164-170. [PMID: 31093888 DOI: 10.1007/s11899-019-00516-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Myeloproliferative neoplasms (MPNs) have a high symptom burden that affects functional status, emotional well-being, and quality of life for patients. Symptom control continues to be a challenging therapeutic goal despite available pharmacologic interventions. The goal of this review is to detail recent efforts that have focused on non-pharmacologic interventions, such as wholistic or integrative medicine, as an adjunctive method to alter symptom burden in this population. RECENT FINDINGS We discuss the ongoing physical, nutritional, and psychological interventional efforts which represent promising non-traditional interventions to date to help reduce symptom in MPN patients. In this article, we highlight the early promising data and importance of these various non-pharmacological interventions to dampen symptom burden and reduce disease-related inflammation. Nonpharmacologic interventions represent promising therapeutic strategies to alter traditional MPN treatment paradigms and improve MPN patient care.
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Affiliation(s)
- Prathibha Surapaneni
- Department of Hematology and Oncology, Mays MD Anderson Cancer Center at UT Health San Antonio, Urschel Tower #U623, 7979 Wurzbach Rd., San Antonio, TX, 78229, USA
| | - Robyn M Scherber
- Department of Hematology and Oncology, Mays MD Anderson Cancer Center at UT Health San Antonio, Urschel Tower #U623, 7979 Wurzbach Rd., San Antonio, TX, 78229, USA.
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